Can someone "dumb down" what Obamacare really means?
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I don't have time to watch the news or read articles so I don't understand much of what is being talked about. Can someone explain to me how it changes for citizens and what it will do to the future... Read More

I'm curious about why your friend's "elderly mother" isn't on Medicare? This story sounds extremely fishy to me -- sort of like all the stories of how people are dying in the streets from lack of care in Canada and the other countries with universal coverage.

She was cut from Medicaid...no coverage at all any longer with that...she does have Medicare, which she had to pay a $4000.00 deductable for a hospital admission plus she no longer has all her perscriptions covered as she did with Medicaid. Medicare is cutting payment through reducing benefits for the elderly and a reduction on reimbursment to hospitals. What IS fishy about that is that medicare is making cuts to benefits, their cuts are not making healthcare affordable.

Aug 16, '12

Since trust has been shaken over agencies or companies that have been entrusted to safeguard the people, I for one am interested to know how many people's medical condition will deteriorate while waiting for a procedure to be green-lit? That concerns me.
I'm not sure with the change in the leadership every few years that these boards would be bias-free.

We are a very large country (we can fit lots of countries in our country) with a large population with different demographics. There are vast areas that are underserved. We also have people coming here from other countries (if you live in FL you know what I'm talking about) who live in their home country during the summer and live on the beach for the winter-to obtain medical care in the US. States with low populations will probably depend on the gov't more than those who have a larger populous that can balance out the costs.

JCAHO has now been tied to CMS to inspect and report any violations-which if not corrected would end any reimbursements from Medicare patients,etc. This is a big power grab. I support safety measures-and applaud some of the changes, but some are completely without merit. Very strange scenarios are presented that would probably occur with these mandates in place.

The one thing I do know, is that these rules and changes are supported until you have been impacted personally. Then you can actually see how it works or doesn't work. Lots of things sound good until you get really sick and will be dealing with the bureaucracy.

The one thing that has happened, since the pocket book has been threatened, hospitals/doctors/other healthcare providers, are cleaning up their act. They see more and more of their patient population dwindling, profits going down, and are scrambling for ways to promote procedures that bring dividends. That's great-we are in the business of taking care of sick people or those who need corrective or elective care/procedures. It's strange that we built a business around sickness, but that's the business we are in. Promoting wellness defeats our purpose so to speak-funny. It will in 20 years or so completely restructure the type of business we are in. You see already many doctors giving up the management of their own private practices and becoming employees of the hospital network-they can't keep up with the regulations or requirements (ex. EHR software) that's big change.

It is going to be interesting-if you think about it, it is a good time to be a nurse.

Aug 16, '12

Sensibility,

You need to stop watching Fox News first.
Second, Food prices are going up because of the drought that has covered most of the central and southern US. That has nothing to do with either party. (unless you believe in global warming which is being blamed on Republicans.) http://www.nytimes.com/2012/07/26/bu...e-drought.html

Third, Gas prices going up also has nothing to do with either party nor any president. If you'll remember, it was under Bush that gas prices skyrocketed in the first place. It's Wall Street that controls that. And if anything Obama has wanted to hamper their ability to screw with those prices but has been blocked by the Republicans. How Wall Street Is Raising the Price of Gas - ABC News

As far as Taxes, Under Obama, according to Politifact.com, they've cut taxes for small businesses not once, not twice, but 17 times. The average family's tax burden is among the lowest it's been in the last 60 years. And, for the middle 60 percent of the income distribution, both the average tax paid and the average tax rate fell between 2008 and 2011. PolitiFact | Barack Obama says taxes are lower for middle class today than when he took office
To the point you made "Eventually, some treatments will be denied and people will die." Excuse me, but insurance companies are doing that right now. There are already people dying because some corporate big wig says a treatment is experimental (aka too costly).

So again, I beg that you stop listening to the right wing controlled media and do some searching the for the truth yourself. Obama has done more for the middle class than any president in 60 years. I'm not trying to sound nasty, I'm just very frustrated because so many people are believing all of the lies from the extremist right wing media without doing some fact checking- my family included.

You don't necessarily need to be a nurse to be a member of this board. Nobody checks to make sure. Please be careful of people that might very well be plants who are obviously giving fallacious information to support socialized medicine. The one guy that said that we have 700 billion dollars in reserve for this is flat out lying. Jeweles26 is giving the right information. We are going to see huge cuts in our salaries and our taxes will go out of the stratosphere meaning less money. Will we be able to reverse this once we're in? Probably not. Most people who support the democratic agenda are constantly arguing that republicans put money into the pocket of the rich. I am sick to death of that argument because it is not true. What a system like the republicans propose does is allow people to prosper, which then causes others to prosper. It means that those people have ability to hire other people and more and more money is available to spend on the things we like. It is just a fact of life that some folks are have more money than others but those people generate jobs for others and hire small businesses to do work etc. My husband's small business is nearly going under with this democratic government especially because of food and gas prices and taxes. See, if you start out with a small business idea, you can prosper under a republican government. Often those who don't have money are the ones who don't want to work. Technically, you could get by in this world with just a few basic items and they want the government to provide those things instead of working hard and making something of themselves. Under a democratic government, it is impossible to prosper because if you make more money, it is less because it places you in a tax bracket where you have to pay more out. So in essence, your situation hasn't changed even though you are supposedly making more. Can you see that? The socialized health care will only further that agenda. Eventually, some treatments will be denied and people will die. Why? Simply because there is not enough money for chronic illnesses that might burden the system. Guess who will survive those things? People who happen to have money. So again, the rich are the only ones who prosper under this where today, those same people get excellent care.

I don't think "fallacious" means what you think it means if you're calling the fact that countries with socialized medicine have lower infant mortality rates and higher life expectancies "fallacious."

But good warning. You don't have to be a nurse. The Koch brothers certainly have the money to pay people to spread lies like calling the ACA "socialized medicine." Quite a few people in this thread that could be right wing plants trying to scare nurses into thinking we're going to make less money and all wait in line for pap smears because of ACA. When most of us (the vagina owning ones) already had our pay threatened by Paul Ryan voting against the equal pay for women act. Which I guess is good for small business, if they only have to pay their penis owning employees a fair wage, they can afford the goods and services whose prices have skyrocketed thanks to the Republican deregulation of the financial industry... Which apparently Barack Obama was supposed to wave a magic wand to fix our economy overnight even though those bankers had a few years to screw it up? Maybe he should have taken a page out of Mitt Romney's business model and sent the job of fixing our economy overseas?

LMBO!!! Right wing plants? I could say the same about you, you sound like you could definitely be some illogical left-winger so far! You speak about the right-wing spreading lies? What about the current lies coming out of the mouths of the Obama administration, including the president himself? All the things they are saying to demonize the right are about as funny as they are insulting! I am no 'plant'. I am in fact a Canadian RN who LEFT the country because I was SICK AND TIRED of paying more than half of my very hard earned salary for people who dont want to work and use the ER as a primary care physician. And they have to, that is the sad part. Why you ask? Because of socialized medicine. Less money going into healthcare means lower salaries, which means less people wanting to stay in this work force. Sure, I love my job. I love taking care of people, making them better, helping them lead healthier lives. But I have a family to support, on top of supporting millions of others with my tax dollars.
If you really dont think the ACA (There, you happy?) will change things in regards to your taxes (and yes, it WILL be the middle class who will feel the hardest sting to their pocket books, not the rich, like Obama would like you to think. Again, I speak from experience), then you are sadly mistaken. Salaries will decrease. Might not be overnight, but it WILL happen. When the hospital has less money to spend, who do you think will suffer from it? They will hire less staff. They will spend less on equipment. They will stop giving pay raises. Just wait and see.
And by the way, having a penis or a vagina has NOTHING to do with ANYTHING, other than the fact that the president is trying to make the mindless masses believe that republicans hate women. Once again, I LMBO.

Aug 16, '12

Oh, and telling people to stop watching Fox news because of its right-wing affiliations? Please. Maybe you should add it to your repertoire after you watch ALL of the other left-wing news networks to at least get two sides of the story, and make your informed decisions from there...

Aug 16, '12

This is why those of us who are not strongly political have such a hard time making informed decisions. There is never a clear cut, if you believe this will work vote this way or if you believe this is better vote that way. Trying to read through the information from our government is difficult. It is wordy, legal jargon that is difficult for the average non-legal citizen to understand. When we try to look to other sources to decipher the information for us we get several different opinions that, in all honesty, often seem to each make valid points! Several different people can interpret the same legal mumbo jumbo and come up with very different interpretations that depending on how you see it might make sense!
I am not focused on politics. I have a career, a family and a rich life. I don't want to run for office or be on the city council. I do however want to participate in making informed decisions. I would like to at least try to be part of the solution to what I view as a huge problem with our medical system. I have read every one of these posts and still feel unqualified to make an informed decision. SAD.

Aug 16, '12

RN-Cardiac, I get where you are coming from. The problem is that we can't get the full truth from either side. Both left-wing and right-wing will tell you their interpretation, and what THEY want you to know about it so you vote for their side. You can't trust the media, because they have all lost sight of the neutrality they are supposed to represent. You can't trust the government, because they are all a bunch of lying D-bags. So what do you do? End up on AN boards where we all end up arguing and being political lol.

Since trust has been shaken over agencies or companies that have been entrusted to safeguard the people, I for one am interested to know how many people's medical condition will deteriorate while waiting for a procedure to be green-lit? That concerns me.

It concerns me that people now are deteriorating and dying waiting on their insurance to green light. Or deteriorating and dying because they don't have access to affordable healthcare.

Although I have seen various opinions to exactly what extent, IPAB's actions are at least somewhat immune from judicial review. Here is text from the law:

''(5) LIMITATION ON REVIEW.--There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of the implementation by the Secretary under this subsection of the recommendations contained in a proposal."

Like many similar boards, the IPAB is an independent group, which is what this is saying; While the IPAB falls under HHS, it is not controlled by the secretary of HHS. This helps provide a 'check and balance' against any potential political bias of the Secretary.

Your example of what is "very different from rationing", to me, clearly is rationing. Which is another problem with the law as it describes what IPAB is prevented from doing. That is, it does not define what rationing is.

And when they do ration, it will be more indirect than what I described. They will not say "people over 80 will not get a knee replacement". Instead, they will simply cut down reimbursement rates for knee replacements for people over 80.

So, you believe that if EBP says that people over 80 can not benefit from a knee replacement, that NO ONE over 80 should get one? You believe that a gov't committee should determine this instead of a physician and patient working together?

Substitute "heart valve replacement" for "knee replacement", and you sound like one of those conservatives who supposedly "want to throw grandma over a cliff."

Rationing healthcare is putting a limit on services regardless of need. For instance, if Medicare was changed to block grants, where once the money ran out for that year no services would be reimbursed (the basis of the Ryan plan), then that would be rationing. Not paying for a service because it is not needed is not rationing. If a patient comes to the ER and demands a head MRI because they stubbed their toe, refusing to pay for that is not rationing. Do you think we should be paying in these situations?

Doctors certainly should be involved, which is why the committee includes Doctors as well as other Health care delivery and evidence experts. Decisions should absolutely be between the patient and their Doctor, although if they decide to do something clearly wasteful (a head MRI for a stubbed toe, etc), that's fine, but I'm not going to financially support their ignorance.

Rationing healthcare is putting a limit on services regardless of need. For instance, if Medicare was changed to block grants, where once the money ran out for that year no services would be reimbursed (the basis of the Ryan plan), then that would be rationing. Not paying for a service because it is not needed is not rationing. If a patient comes to the ER and demands a head MRI because they stubbed their toe, refusing to pay for that is not rationing. Do you think we should be paying in these situations?

Doctors certainly should be involved, which is why the committee includes Doctors as well as other Health care delivery and evidence experts. Decisions should absolutely be between the patient and their Doctor, although if they decide to do something clearly wasteful (a head MRI for a stubbed toe, etc), that's fine, but I'm not going to financially support their ignorance.

You example is obvious. I would agree that would not be rationing and that the gov't should not pay for it. However, most situations are not so black and white.

How about going back to my hypothetical example: You said earlier that it is ok for a gov't board deciding that no one over the age of 80 will get a knee replacement if EBP says it is wasteful? That is taking decisions out of the hands of patients and doctors.

Would cutting reimbursements for knee replacements for people over 80 be considered rationing?

You believe in cookie-cutter medicine...one size fits all. In which case, the ACA will work better for you then for most people.

Aug 16, '12

Muno,...I'm going to sort of play devils advocate for a second. I am not affiliated with any particular political party, and to be honest I'm very ill informed about political issues in general,...however I am a nurse and for the last 6 years of my career I've been in a level I Trauma ED. One of my biggest frustrations at work is waste of resources! I understand that your example is an extreme exaggeration,..but what about the not so extreme cases? Who decides what is ignorant waste and what is necessary? How will that decision be made and made in a timely manner? For instance I frequently see people in the ED who have abdominal pain. They have seen their PCP and are scheduled for a CT/HIDA scan/US (whatever) next week,..."but I just can't wait that long!" They have been seen by a doctor who thought they could wait that long. These tests through the ED are very expensive, and take time/resources from true emergencies. How do we decide what gets paid for? What if the ED doc disagrees with the PCP? Better yet,...what happens when we miss a hot appy, AAA etc? I personally think we need fewer lawyers, and and a greater sense of personal responsibility, but as I don't see that happening anytime soon,...how will we make this cost cutting plan work?

Aug 16, '12

Medicare and Medicaid to an extent already ration (if that is the proper word) care. Based upon age of the patient and several other factors certain proceedures/treatments are not supposed to happen (colonoscopies, prostrate treatment etc) and or aren't in theory reimbursed. Problem is hospitals and physicans have created a vast and complex coding systems which allow them to bill and get paid regardless. Yes, often an audit will turn up the "over billing" and take correction happens but not nearly enough to stamp out the waste, fraud and abuse.

On the wider topic of rationing care in general, it is going to happen in one form or another and depending upon one's current age and or health the effects may be felt sooner or later. One does feel that those at or near "senior" status are safe for now, but as for our children, grand and certainly great grandchildren all bets are off.

The United States spends more on healthcare than any other nation on earth with no better outcomes than most. Much of these costs can be attributed to mismanaged and or over care of those with either terminal illness and or nearing the last stages of life. Posted a link elsewhere in the "news" forum to a NYT story about a young man who after having a heart transplant eventually died but not before earning the distinction of being one of the most expensive Medicare/Medicaid patients to date.

To read the aforementioned story is a lession in the "normal" for healthcare in much of the United States, that is the practice of always doing "something" even if that something leads to having to do something else to reverse/mitigate the effects of the previous treatment/proceedure. And so it goes until there are so many comorbidities that the treatment results in a balkanised system of care with each department defending their flanks and the poor patient caught in the middle.

America could slash it's overall healthcare tab if it put more funds and emphasis on preventive care regardless of income. In particular expecting mothers, moms, infants and children. France offers what is widely regarded as one of the best pre-natal, maternity and early child healthcare systems and they do so spending a fraction of the USA and with much better infant mortality rates as well.